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Dear Dr. Saltzman,

I am a 52 year-old woman who lives in California. I have been seeing a psychiatrist for about 5 years. The original purpose was for help with my son (who he subsequently saw) who has OCD. We have worked through many, many other issues also -- my depression, addiction to alcohol, problems with my marriage, etc. He is very open about his own life and struggles including those with his three children (rehab, fights, job searches, boyfriends) and a bit less so about his wife, although I would occasionally hear the details of a fight they had. [His wife sickened and died. At Caroline's--not her real name--request I have redacted the details of her illness.]

After her death, there were many sessions where the only thing we talked about was his wife. Then he began talking about dating and girlfriends. [At Caroline's request I have redacted the details of more recent conversations with the therapist which include detailed information about his sexual behavior.]

After he tells me this type of information I usually spend several nights not sleeping well.



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I know that I have very strong feelings for him because he has been incredibly helpful in some very difficult situations. We have talked about my fears of falling in love with him if I get too close to him and depend on him too much. He assures me that as long as we keep the boundaries of not touching each other and not doing anything together outside of the therapy setting, that these feelings are normal and that we will use them to help me transfer those feelings to my husband.



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I also know that, in reality, I wouldn't want to have sex with him because he's just too kinky. However, there is also a big part of me that is jealous when I hear these stories because that same part of me wants him to be in love with me.

I don't want to change therapists because I don't have the energy to start over and have to learn to trust someone else (trust is a hugh issue for me). Is my therapist out of line? What should I do?

If you publish an answer to me letter PLEASE do not use my name and PLEASE leave many of these details out. Although I know that he shares a lot of personal information with most of his patients, I suspect that I have heard more then most and I worry that he would immediately know who wrote this letter if he were to somehow see it.

If possible, I would like an answer from you that isn't published on your web site, although I know that you probably get too many letters to accommodate such requests.

Thank you,

Caroline






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Caroline--

In my view, your psychiatrist is entirely out of line and has been all along. I think that you already know that, and have written to me only for confirmation of what you already know. If a therapist is any good at all, you should hear little or nothing about his personal life. A competent therapist might indicate that he or she is married or not, and perhaps that he or she has children, although even this, in my view, might not always be advisable. But if a therapist mentions any personal details beyond such generalities, I consider this either a form of seduction of the patient, or an attempt to use the therapy hours for the therapist’s own therapy, either of which is, in my view, tantamount to malpractice. If a patient of mine were to ask about my personal life, I would reply that, "We are here to talk about you, not to talk about me," and I certainly would not volunteer any such information.

This idea that you will be able to "transfer" your hot feelings for the therapist to your husband is pure bullshit, and betrays his ignorance about what constitutes a therapeutic transference. In fact, your saying that you want your therapist to be in love with you indicates how badly this "therapy" already has damaged and endangered your marriage, which I am sure you also know.



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As you requested, I have redacted the details of his conversations with you about sex and girlfriends, but it is apparent to me that this person is obsessed with sex, imagines himself to be an object of female desire, and has used your therapy sessions to add you to the list of women—his patients mostly, I suspect—who are "in love" with him. For a doctor who sees people at their most vulnerable, needing help, and psychologically naked, this is shameful behavior. In short, your doctor has abused you and, by sexualizing your therapy sessions with confessions about his kinky desires, misused his power in the situation, taking unfair advantage of your vulnerability simply to demonstrate to his own obviously fragile ego that he is the object of desire which he imagines himself to be. The closest analogy I can think of right now would be a gynecologist who exposed his penis and masturbated while examining a patient. In other words, the "treatment" is for his gratification, not for the benefit of the patient. Professionals of any stripe are duty bound to leave their personal lives--particularly their sexuality--out of the workplace, and I think you really already knew that before writing to me, Caroline.

In my opinion, you should cancel any further meetings with this fraudster right away. He already has seduced you into falling in love with him, and, despite his psychobabble about "transferring your desires onto your husband--which is just crap--this is not what is supposed to happen in a therapeutic transference. The feelings that a patient has for the therapist which are called "transference" refer to feelings that the patient had for early caregivers transferred onto the person of the therapist, not feelings for the therapist that have arisen because the therapist has involved the patient in his or her personal life, and has spoken about sex in a personal way. In certain styles of therapy transference is analyzed--explained, that is--to the patient, so that the patient can become aware of his or her habitual way of dealing with other adults as if they were parents or siblings. In other modes of therapy, the transference is not explained to the patient, but used by the therapist as a way of understanding the psychological landscape of the patient. But in no form of therapy at all are feelings of sexual attraction to the therapist encouraged so that later they can be "transferred" to someone in the patient's private life. This is arrant nonsense.

You are being taken for a ride by someone who, judging from your sad tale, should not be working in this profession. Again, I advise you to get a new therapist no matter how much extra work that will entail. The new therapist will be able to help you to repair the damage that this bozo has done.

Be well.







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Dr. Saltzman,

Thank you for your prompt reply. I was afraid you were going to say just what you did. I keep trying to tell myself that I'm not in love with him. If I am in love with him is it because he has shared his personal life or because he has been the only person who has been patient enough to let me get to the point where I can safely talk about things I have never before dared to put into words and take the risk of letting someone judge me? I had tried a couple of other therapists and was never able to become comfortable enough to take the chance of revealing and being able to explain the deep loneliness and self-hatred that I live with. In fact, sometimes I felt like I was talking to the wall, which I can do at home for free!

In many ways, his openness about his own life (although I agree he's gone too far in the latest case) is what has made me not be afraid of exposing my own well-hidden shames and secrets. I don't understand how knowing about his life can work to seduce me. It isn't like he's given me any illusions that he's going to run off with me or that the feelings will ever be reciprocated.

One of the hardest things in the world for me to do is trust someone. He has assured me over and over that I can trust him with my fears and such, and that he won't hurt me. Unfortunately, now I'm hurt both ways. Plus, my feelings for my early caregivers are not pleasant and I can't imagine wanting to "transfer" them to anyone else. I don't see how that is going to heal me. This doctor has been instrumental in my being sober for 14 1/2 months after almost 30 years of abusing and then being addiction to alcohol--the addiction, I believe, being a way to escape the pain of such a fundamentalist and sometimes abusive upbringing that no matter how I look at it, I believe that I am literally doomed to an eternity of hell.

This is all so very confusing to me and the idea of letting him go is a tough one. If I do leave the therapy, should I be honest about why I'm doing so?

Thank you for giving me your time and objective opinion. Before I stumbled onto your website I had not figured out anyone I could freely ask these questions to.

Caroline







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Caroline--

Look, you say that trust is difficult for you, but you have trusted me. And I suspect that you already knew that there was a problem with this guy. Otherwise, why would you have written to me? I am more than familiar with this kind of story because in my own practice, unfortunately, I have had often to help a client undo the damage caused by one of these narcissistic "doctors," who need therapy themselves, and who use conversations with their patients to prop themselves up instead of admitting that they need some therapy themselves and getting it.

Caroline, the most basic rule of effective depth psychotherapy is this: the therapist must not, as you said, gain your confidence by sharing his personal life with you, but by listening to you, hearing you, and showing you that he (or she) understands you.



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Then, if through the phenomenon of transference you begin to treat him as if he was one of your early caregivers, the emotions involved will provide further information which the therapist will use to understand your pain. In other words, awareness of the transference is important because by noticing and analyzing the transference, the therapist can gain immediate access and often very deep insight into the rhythms and necessities of the patient's emotional life. Sharing ones personal life with the patient forecloses that possibility because then the patient is reacting not to her own past material, but to the material of the therapist. In other words, your therapy is a failed therapy because your therapist, for his own purposes, has polluted the therapeutic space with his kinky ideas which even destroy your sleep. Now in your case, Caroline, if the space for transference had not been polluted by this incompetent: You were disappointed in your early caregivers, so eventually you might have acted in ways that would indicate to your therapist that you are disappointed in him or in the therapy. A good therapist would not take any of that "disappointment" personally, but would slowly and carefully interpret it for you so that eventually
you would come to understand that you have been projecting your early disappointment not just onto your therapist, but onto others in your adult life—essentially everyone you meet--which is what is causing your loneliness. I am oversimplifying greatly here—actually the matter is far more complicated--but that is the basic idea.

Unfortunately, your therapist has short-circuited this healing process by being too forthcoming about his own life. In other words, he has blathered about his own pain and about his sex life for his own reasons which have nothing to do with you, so that now you are hung up on him, his dead wife, his girlfriends, and his kinky sexual habits, instead of using the therapy time to work on yourself, and your own real problems.





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Now you say that this man has helped you with alcoholism. Perhaps he did, but he has left you injured by the therapy, which you yourself acknowledge: "Unfortunately, now I'm hurt both ways." I strongly advise you to stop giving this man any credit at all. He has hurt you, not helped, your months of abstinence from alcohol notwithstanding. It's fine to be sober if you had been abusing alcohol, but sobriety is not mental well-being, which you obviously lack, and which you will be able to attain with the aid of some real therapy.

As I see it, you should leave this so-called “therapy,” which really isn’t therapy, right away. It does not matter what you tell this quack about leaving. He is a poor excuse for a therapist and, in my opinion deserves neither explanation nor honesty, only goodbye. If you really need to tell him something, show him our correspondence. I would love to hear from him! In fact, your wanting him not to find out about your communication with me--asking me to answer you privately, or, failing that, to disguise your identity--just futher indicates the extent to which this man has you (along with a lot of other patients, I would bet) under his thumb. He has done wrong. He has cheated you. You have paid him by the hour to have to listen to his ravings which have left you injured and wanting him to be in love with you, despite his kinky sex life which, unfortunately, you know everything about. This therapy is a failure which has left you worse off than when you began. Why shouldn't he be confronted with it?

Sorry. I know this hurts, but you wrote to me for a honest opinion from an objective and experienced person who has nothing to gain. This is it.

Be well.





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Dear Dr. Saltzman,

Thank you for your very direct and blunt words. I wanted an honest, objective opinion and I got one.

Thinking through the many comments he has made over the years--telling me that I am "sexy" for example--that I didn't have time or need to include in my recitation of the situation, I am putting together in my mind just how I got into this spot. It is helping me see that I do need to move out of the relationship. I just called him and and left a message canceling my appointment for tomorrow. Because I know him so well and I know for sure that this is his general approach to his patients, i.e., I am not the only patient in this situation, I felt inclined also leave a message that I feel he has crossed too many boundaries for this to any longer be considered therapy. I told him that in essence I believe that in many ways I've have become his therapist. I decided to leave my input that I think he is screwing up across the board in the hope that it might possibly help other patients. I know he will call and want to talk about it, but as an ex-attorney (I call myself a "recovering lawyer"), it's not in my personality to just let it go without calling him on his behavior.

Now I just need to figure out what to do about another doctor because I'm on some medications. Some I think I can slowly discontinue, but some I think have helped a lot and would like to stay on them. I don't trust general internists to prescribe these medications so I'll have to do some research beyond my regular doctor.

Thanks again and wish me luck in talking to him!

Caroline










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